Importance: Hypertension poses a significant public health challenge. Despite clinical practice guidelines for hypertension management, clinician adherence to these guidelines remains suboptimal.
Objective: This study aims to develop a taxonomy of suboptimal adherence scenarios for severe hypertension and identify barriers to guideline adherence.
Design: We conducted a qualitative content analysis using electronic health records (EHRs) of Yale New Haven Health System who had at least two consecutive visits between January 1, 2013, and October 31, 2018.
Setting: This was a thematic analysis of EHR data to generate a real-world taxonomy of scenarios of suboptimal clinician guideline adherence in the management of severe hypertension.
Participants: We identified patients with markedly elevated blood pressure ([BP]; defined as at least 2 consecutive readings of BP ≥160/100 mmHg) and no prescription for antihypertensive medication within a 90-day of the 2 BP elevation (n=4,828). We randomly selected 100 records from the group of all eligible patients for qualitative analysis.
Main Outcomes And Measures: The scenarios and influencing factors contributing to clinician non-adherence to the guidelines for hypertension management.
Results: Thematic saturation was reached after analyzing 100 patient records. Three content domains emerged: clinician-related scenarios (neglect and diffusion of responsibility), patient-related scenarios (patient non-adherence and patient preference), and clinical complexity-related scenarios (diagnostic uncertainty, maintenance of current intervention and competing medical priorities). Through a metareview of literature, we identified several plausible influencing factors, including a lack of protocols and processes that clearly define the roles within the institution to implement guidelines, infrastructure limitations, and clinicians' lack of autonomy and authority, excessive workload, time constraints, clinician belief that intervention was not part of their role, or perception that guidelines restrict clinical judgment.
Conclusions And Relevance: This study illuminates reasons for suboptimal adherence to guidelines for managing markedly elevated BP. The taxonomy of suboptimal adherence scenarios, derived from real-world EHR data, is pragmatic and provides a basis for developing targeted interventions to improve clinician guideline adherence and patient outcomes.
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http://dx.doi.org/10.1101/2024.01.12.24301223 | DOI Listing |
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Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania.
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Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), 8005-139 Faro, Portugal.
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Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; Department of Microbiology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
Paediatric blood cultures are vital for the diagnosis of paediatric bloodstream infections. Quality of paediatric blood culture collection, processing and reporting depend on multiple factors, with a paucity of literature describing these in practice. We conducted separate surveys of clinicians and laboratory staff to assess quality standards and knowledge related to paediatric blood culture collection, analysis, and interpretation to identify improvement opportunities.
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Institute of Physiology, University of Zurich, Zurich, Switzerland; Division of Nephrology, Cliniques universitaires Saint-Luc, UCLouvain Medical School, Brussels, Belgium. Electronic address:
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